Using a selective a-blocker for medical expulsive therapy (MET) is an effective treatment approach widely used for ureteral stones.
To assess the efficacy and safety of silodosin in medical expulstion therapy compared to placebo and tamsulosin EVIDENCE ACQUISITION: A systematic search was performed in PubMed, Cochrane Library, and Embase to identify randomized controlled trials that compared silodosin with a placebo or tamsulosin for ureteral calculi.
Eight publications involving a total of 1048 patients were used in the analysis, which compared silodosin with placebo and tamsulosin. We found that silodosin was effective in treating ureteral calculi in our meta-analysis, which was superior to tamsulosin in its efficacy. The expulsion rate of all ureteral stones (OR = 1.59, 95%CI = 1.08 to 2.36, p = 0.02); the expulsion rate of distal ureteral stones (OR = 2.82, 95%CI = 1.70 to 4.67, p < 0.0001); the expulsion time (days) of distal ureteral stones (SMD = -4.71, 95%CI = -6.60 to -2.83, p < 0.00001) indicated that silodosin was more effective than the placebo. Moreover, expulsion rate (OR = 2.54, 95%CI = 1.70 to 3.78, p < 0.00001); expulsion time (days) (SMD = -2.64, 95%CI = -3.64 to -1.64, p < 0.00001); pain episodes (p < 0.00001) indicated that silodosin was more effective than the tamsulosin. Even though silodosin had a significant increase in abnormal ejaculation compared with tamsulosin, no significant differences were observed for complication (OR = 1.00, 95%CI = 0.58 to 1.74, p = 1.00).
This meta-analysis indicates that silodosin was superior to placebo or tamsulosin in the efficacy for distal ureteral calculi with better control of pain. Safety profile of silodosin was similar to tamsulosin though retrograde ejaculation was worse for silodosin use. We conclude that silodosin might have potential as a MET for ureteral stones.
British journal of clinical pharmacology 2015 Aug 10 [Epub ahead of print]
Wei Huang, Peng Xue, Huantao Zong, Yong Zhang
Urology Department, Beijing Tian Tan Hospital, Capital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, China , Urology Department, Beijing Tian Tan Hospital, Capital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, China , Urology Department, Beijing Tian Tan Hospital, Capital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, China , Urology Department, Beijing Tian Tan Hospital, Capital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, China